早期 IB1 期宫颈癌中较少与更多激进手术的比较：长期生存的基于人群的研究。
Less versus more radical surgery in stage IB1 cervical cancer: A population-based study of long-term survival.
机构信息
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
出版信息
Gynecol Oncol. 2018 Jul;150(1):44-49. doi: 10.1016/j.ygyno.2018.04.571.
BACKGROUND
Standard surgical treatment for women with stage IB1 cervical cancer consists of radical hysterectomy. This study assesses survival outcomes of those treated with less radical surgery (LRS; conization, trachelectomy, simple hysterectomy) compared to more radical surgery (MRS; modified radical, radical hysterectomy).
METHODS
Using the Surveillance, Epidemiology and End Results database, we identified women <45 years with FIGO stage IB1 cervical cancer diagnosed from 1/1998 to 12/2012. Only those who underwent lymph node (LN) assessment were analyzed. Disease-specific survivals (DSSs) of LRS were compared with those of MRS.
RESULTS
Of 2571 patients, 807 underwent LRS and 1764 underwent MRS, all with LN assessment. For LRS vs. MRS, 28% vs. 23% were diagnosed with adenocarcinoma (p = 0.024), 31% vs. 39% had G3 disease (p < 0.001), 40% vs. 45% had tumor size >2 cm (p < 0.001), and 27% vs. 29% received adjuvant radiation therapy (p = 0.005). Median follow-up was 79 months (range, 0-179). Ten-year DSS for LRS vs. MRS was 93.5% vs. 92.3% (p = 0.511). There was no difference in 10-year DSS when stratified by tumor size ≤2 cm (LRS 95.1% vs. MRS 95.6%, p = 0.80) or > 2 cm (LRS 90.1% vs. MRS 88.2%, p = 0.48). Factors independently associated with increased risk of death included adenosquamous histology (HR 2.37), G3 disease (HR 2.86), tumors >2 cm (HR 1.82), and LN positivity (HR 2.42). Compared to MRS, LRS was not associated with a higher risk of death.
CONCLUSIONS
In a select group of young women with stage IB1 cervical cancer, LRS compared to MRS does not appear to compromise DSS.
背景
对于 FIGO 分期 IB1 期的宫颈癌患者，标准的外科治疗方法为根治性子宫切除术。本研究旨在评估与根治性手术（MRS；改良根治术、根治性子宫切除术）相比，采用较不激进的手术（LRS；子宫颈锥形切除术、子宫颈管切除术、单纯子宫切除术）治疗的患者的生存结局。
方法
本研究使用监测、流行病学和最终结果数据库，纳入了 1998 年 1 月至 2012 年 12 月期间诊断为 FIGO 分期 IB1 期宫颈癌且年龄＜45 岁的女性患者。仅分析了接受淋巴结（LN）评估的患者。比较 LRS 和 MRS 患者的疾病特异性生存率（DSS）。
结果
在 2571 例患者中，807 例行 LRS，1764 例行 MRS，均行 LN 评估。与 MRS 相比，LRS 组中腺癌的比例为 28% vs. 23%（p=0.024），G3 疾病的比例为 31% vs. 39%（p＜0.001），肿瘤直径＞2cm 的比例为 40% vs. 45%（p＜0.001），接受辅助放疗的比例为 27% vs. 29%（p=0.005）。中位随访时间为 79 个月（范围，0-179）。LRS 和 MRS 患者的 10 年 DSS 分别为 93.5% vs. 92.3%（p=0.511）。肿瘤直径≤2cm 时（LRS 95.1% vs. MRS 95.6%，p=0.80）或＞2cm 时（LRS 90.1% vs. MRS 88.2%，p=0.48），10 年 DSS 无差异。与死亡风险增加相关的独立因素包括腺鳞癌组织学（HR 2.37）、G3 疾病（HR 2.86）、肿瘤直径＞2cm（HR 1.82）和 LN 阳性（HR 2.42）。与 MRS 相比，LRS 并不增加死亡风险。
结论
在患有 IB1 期宫颈癌的年轻女性亚组中，与 MRS 相比，LRS 似乎不会降低 DSS。
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